Perinatal and long-term outcome of endoscopic laser surgery for twin-twin transfusion syndrome with and without selective fetal growth restriction: A retrospective cohort study.

OBJECTIVE: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. METHODS: Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age. RESULTS: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31). Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. CONCLUSIONS: In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups.

Unraveling the effect of silent, intronic and missense mutations on VWF splicing: contribution of next generation sequencing in the study of mRNA.

Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. clinicaltrials.gov identifier:02869074.

Multirefractory primary immune thrombocytopenia; targeting the decreased sialic acid content.

Patients with multirefractory immune thrombocytopenia (ITP) have limited treatment options. Recent data suggest that specific anti-platelet antibodies may cause destruction of platelets by favoring platelet loss of sialic acid. In this multicenter study 35 patients with ITP, including 16 with multirefractory disease, were analyzed for antiplatelet-antibodies, thrombopoietin (TPO) levels, and platelet desialylation. In selected cases, responses to a novel treatment strategy using oseltamivir were tested. We found that antibodies against GPIbα were overrepresented in multirefractory patients compared to responders (n = 19). In contrast to conventional ITP patients, multirefractory patients exhibited a significant increased platelet activation state (granule secretion) and desialylation (RCA-1 binding) (p < 0.05), and a trend toward higher plasma TPO concentrations. The decreased sialic acid content seemed to be restricted to platelet glycoproteins, since other plasma proteins were not hypoglycosylated. A total of 10 patients with multirefractory ITP having remarkable loss of platelet terminal sialic acids were given oseltamivir phosphate. When the antiviral drug was combined with TPO receptor agonists (TPO-RAs) or with immunosuppressant drugs, platelet responses were observed in 66.7% of patients. All responding patients presented with antibodies reactive only against GPIbα. These findings suggest that desialylation may play a key pathogenic role in some multirefractory ITP patients, and provide diagnostic tools for the identification of such patients. Furthermore, we show that sialidase inhibitor treatment in combination with therapies that help to increase platelet production can induce sustained platelet responses in some patients with anti-GPIbα -mediated thrombocytopenia that have failed previous therapies.

Incorporation of ZnCl2 into an etch-and-rinse adhesive system on flexural strength, degree of conversion and bond durability to caries-affected dentin.

PURPOSE: To evaluate the effect of a zinc chloride (ZnCl2) solution (2% wt), incorporated into a two-step etch-and-rinse adhesive system (AS), on microtensile bond strength (µTBS) to caries-affected dentin (CAD). METHODS: First, the degree of conversion (DC) of the AS with and without the ZnCl2 solution was evaluated by Fourier transform infrared spectroscopy (FTIR). Second, beam-shaped samples (7 mm × 2 mm × 1 mm) were prepared with the AS containing the ZnCl2 solution to perform flexural strength (FS) tests. For µTBS testing purposes, CAD surfaces were etched with phosphoric acid and randomly divided into three groups (n=10) : ZnCl2- AS with ZnCl2; NT (no treatment)- AS without ZnCl2; and CHX - pretreatment with 2% chlorhexidine solution. AS (Adper Single Bond 2) was applied according to the manufacturer's instructions, and resin composite restorations were built up. After 24 hours, the resin-dentin blocks were sectioned into specimens (0.8 mm2), and then subjected to micro;TBS testing immediately following, or after 6 or 12 months of water storage (WS). The adhesive interface was evaluated by scanning electron microscope. Both µTBS and FS tests were performed using a universal testing machine ( 0.5 mm/minute). FS and DC data were submitted to the Student t-test, and µTBS data were subjected to two-way ANOVA and Tukey's test (α= 0.05). RESULTS: DC was not affected by ZnCl2 incorporation into AS (P= 0.2527). Higher FS values were obtained in the group with ZnCl2 added to AS. Regarding µTBS, the mean of the NT group was statistically higher than that of the ZnCl2 or the CHX groups (P< 0.001(, regardless of WS, but the latter groups did not differ from each other. µTBS at 24 hours was statistically superior to that of 6 and 12 months of WS (P< 0.001).

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]. / Prevalencia en la realización de mamografías en España: análisis por comunidades 2006-2014 y factores que influyen.

OBJECTIVE: To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. DESIGN: Transversal study. SITES: Spain. PARTICIPANTS: A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. MEASUREMENTS: The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. RESULTS: The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. CONCLUSIONS: Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.

Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): comprehensive genetic analysis by next-generation sequencing of 480 patients.

Molecular diagnosis of patients with von Willebrand disease is pending in most populations due to the complexity and high cost of conventional molecular analyses. The need for molecular and clinical characterization of von Willebrand disease in Spain prompted the creation of a multicenter project (PCM-EVW-ES) that resulted in the largest prospective cohort study of patients with all types of von Willebrand disease. Molecular analysis of relevant regions of the VWF, including intronic and promoter regions, was achieved in the 556 individuals recruited via the development of a simple, innovative, relatively low-cost protocol based on microfluidic technology and next-generation sequencing. A total of 704 variants (237 different) were identified along VWF, 155 of which had not been previously recorded in the international mutation database. The potential pathogenic effect of these variants was assessed by in silico analysis. Furthermore, four short tandem repeats were analyzed in order to evaluate the ancestral origin of recurrent mutations. The outcome of genetic analysis allowed for the reclassification of 110 patients, identification of 37 asymptomatic carriers (important for genetic counseling) and re-inclusion of 43 patients previously excluded by phenotyping results. In total, 480 patients were definitively diagnosed. Candidate mutations were identified in all patients except 13 type 1 von Willebrand disease, yielding a high genotype-phenotype correlation. Our data reinforce the capital importance and usefulness of genetics in von Willebrand disease diagnostics. The progressive implementation of molecular study as the first-line test for routine diagnosis of this condition will lead to increasingly more personalized and effective care for this patient population.

Effectiveness of three interventions to improve participation in colorectal cancer screening.

BACKGROUND AND OBJECTIVE: Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. METHODS: We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. RESULTS: A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written information group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. CONCLUSIONS: Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals.

[USE OF NNN LANGUAGE IN LOCAL CARE OF BURN INJURIES]. / Lenguaje NNN en los cuidados locales de las quemaduras.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can seriously be compromised. In this chapter, the intention is to clarify the nursing care for the affected area, once patient's life risk is stabilized and controlled. This care should be based on an adequate approach to local handling of burn injuries, after their severity and prognosis have been stated. To do this, it will be used the standardized nursing language NNN, referring to Nursing Diagnosis NANDA (North American Nursing Diagnosis Association), Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). This taxonomy is very useful to describe the Nursing clinical practice of burns care because it can easily be used by nurses participating in the care of this type of patients. Nursing plans using the NNN taxonomy can be designed using existing software applications.

[SAFETY IN THE ELDERLY: HOME ACCIDENTS]. / Seguridad en personas mayores: accidentes en el hogar.

Home accidents are more common in the elderly and they can have serious consequences to the injured person's health. At home, chances to suffer accidents of any type are higher, because it's the place where old people spend most of their daily time. It is important to point out that a high percentage of domestic accidents could be easily avoided by taking some simple cautions. The main aim of this paper is to know how we can prevent most common domestic accidents in the aged population: falls, burnings, poisonings and fire prevention.

[Elderly caregivers of elderly people].

The ageing of the population is a reality in our society nowadays. The aging process changes increase the probability that health problems occur. This fact involves that the needs of care demanded by the population increase too. The care for the elderly generally are provided in home environments, where often, the primary caregiver is another old person. In this sense, must be taken into account that this stage of life, the old age, although there has been important improvements in the quality of life and in the resolution of health problems, presents certain limitations refers to physical and mental declines that affect to the functional capacity of elderly caregivers. For this reason, it is necessary to carry out a comprehensive geriatric assessment to identify unresolved needs and establish care strategies required to attend their demands for care.

Prevalence of hazardous drinking among nursing students.

AIMS: To estimate the frequency of alcohol consumption among nursing students and describe their behaviour patterns in relation to excessive consumption. BACKGROUND: Most alcohol-related problems appear in individuals who indulge in hazardous consumption, with hazardous drinkers constituting a priority in the field of preventive activities. According to previous studies, there is a high proportion of hazardous drinkers among university students. DESIGN: Descriptive cross-sectional study. METHODS: Over the course of the 2012-2013 academic year, we assessed 1060 nursing degree students, ascertaining their socio-demographic characteristics, lifestyle and alcohol consumption by means of the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcohólicos/ISCA) and Alcohol Use Disorders Inventory Test (AUDIT). RESULTS: Hazardous alcohol consumption was observed in 43·4% of students. Moreover, 14·9% of men and 18·7% of women met criteria for hazardous drinkers, without any statistically significant difference between the sexes. The frequency of hazardous drinkers was significantly higher among participants aged under 21 years, those living outside the family nucleus and smokers. CONCLUSION: A considerable proportion of students show evidence of hazardous alcohol consumption and, while there are no sex-related differences, the proportion of hazardous drinkers tends to be higher among the youngest subjects, smokers and persons living outside the family nucleus. Alcohol-prevention activities should envisage greater protection of university settings, particularly where future health professionals are involved.

4-amino bis-pyridinium derivatives as novel antileishmanial agents.

The antileishmanial activity of a series of bis-pyridinium derivatives that are analogues of pentamidine have been investigated, and all compounds assayed were found to display activity against promastigotes and intracellular amastigotes of Leishmania donovani and Leishmania major, with 50% effective concentrations (EC50s) lower than 1 µM in most cases. The majority of compounds showed similar behavior in both Leishmania species, being slightly more active against L. major amastigotes. However, compound VGP-106 {1,1'-(biphenyl-4,4'-diylmethylene)bis[4-(4-bromo-N-methylanilino)pyridinium] dibromide} exhibited significantly higher activity against L. donovani amastigotes (EC50, 0.86 ± 0.46 µM) with a lower toxicity in THP-1 cells (EC50, 206.54 ± 9.89 µM). As such, VGP-106 was chosen as a representative compound to further elucidate the mode of action of this family of inhibitors in promastigote forms of L. donovani. We have determined that uptake of VGP-106 in Leishmania is a temperature-independent process, suggesting that the compound crosses the parasite membrane by diffusion. Transmission electron microscopy analysis showed a severe mitochondrial swelling in parasites treated with compound VGP-106, which induces hyperpolarization of the mitochondrial membrane potential and a significant decrease of intracellular free ATP levels due to the inhibition of ATP synthesis. Additionally, we have confirmed that VGP-106 induces mitochondrial ROS production and an increase in intracellular Ca(2+) levels. All these molecular events can activate the apoptotic process in Leishmania; however, propidium iodide assays gave no indication of DNA fragmentation. These results underline the potency of compound VGP-106, which may represent a new avenue for the development of novel antileishmanial compounds.

[What do we need to know about the burn injuries? Pathophysiology, aetiology and effects]. / ¿Que necestamos saber sobre las quemaduras? Fisiopatología, etiología y repercusiones.

Burn injuries are a major public health problem worldwide, because they are very common. They are usually produced in domestic or work environments, although it is not unusual that they might be caused by traffic accidents or intentionally (self-injured or assaults on the people). These injuries do not attract much attention but if they are not treated properly, they can lead to serious systemic complications which can sometimes cause the death of the patient. In the last few years, the therapeutic approach of the burned patient has significantly improved due to an early correct initial valuation, which is used to design an effective nursing care plan and it determines the prescription of a suitable medical treatment according to the characteristics and the severity of the burn. The aim of this chapter is to explain some general aspects about the aetiology and pathology of burn injuries and their systemic effects, because the medical and nursing staff should know these aspects to make an adequate initial valuation. They should recognize the aetiology of the burn, its depth and area, its severity and its systemic complications to act properly in the initial phase of the treatment, because these preliminary actions are essential in the prognosis and evolution of the burns.

[Local nursing care in burn injuries]. / Cuidados de enfermería locales en las quemaduras.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can be seriously compromised. An estimate 300 people for every 100,000 inhabitants are treated for burn injuries every year in hospitals or social-sanitary centers. In this chapter we aim at clarifying the nursing care for the affected area, once patient's life risk is stabilized and controlled.This care will be based on an adequate approach to local handling of burn injuries, after severity and prognosis have been stated.

[Sequelae in patients with severe burns]. / Secuelas en los pacientes con quemaduras graves.

Nowadays, the main aim with severe burned patients is the prevention and treatment of the complications associated to burn injuries, because the mortality caused by them has significantly declined due to the improvements in the treatments used. This fact has changed the focus of the care from a biomedical model which pay attention to the physical aspects, to other based on the holistic care of the patient in which physical, psychological and social aspects are considered. To minimize the development of these adverse complications and to prevent their severity in long term, it is essential to initiate an early rehabilitation at hospital and follow these patients by the Primary Care team when they return home. The adverse effects of the burns can invalidate the patient and they can affect several spheres of his life: physical, psychological and social. The goals of this article are to determine the most common complications in severe burns, describe the treatments more effective to combat them and explain the role of nurses in the prevention and rehabilitation of these injured.

[Therapeutic guide to local care of burn injuries]. / Guía terapéutica en el cuidado local de las quemaduras.

There is a large variety of topical application substances in the market for burnt areas treatment. This fact, far from being an advantage, turns into a serious problem when nursing staff has to choose the most adequate for each case. We think that, apart from a thorough knowledge of aspects such as indications and contraindications, application methods, combination with other substances and possible interactions, the formulation of a series of practical criteria can be of great help in order to select the right topical substance for the objectives pursued. This is the goal of this article.

[Therapeutic guide to critical burn patients]. / Guía terapéutica en el paciente quemado crítico.

Burn injuries are defined as the destruction of skin tissue under the effects of a thermal, electrical, chemical or radioactive agent. They can cause local injuries, with no systemic effect, but in certain cases, considered as "critical burn patients", they can produce severe and immediate systemic injuries, thus making it necessary to address care from a comprehensive perspective in order to achieve a satisfactory evolution. With this in mind, as nursing staff we must consider the need to review the treatments and nursing care we are applying to critical burn patients, in order to prevent the onset of complications that might lead to unwanted consequences or even the death of the patient, and eventually unifying criteria of nursing care. The main goal of this guide is to provide an efficient and easy to use working tool that is suitable for adult burn patients, thus making it easier for nurses to update knowledge and decision making.

The attitudes of primary care providers towards screening for colorectal cancer.

BACKGROUND AND OBJECTIVE: the scientific community supports the appropriateness of colorectal cancer screening, and there is consensus on the need to raise awareness about the significance of prevention among both health care professionals and the population. The goal was to record the attitude of primary care providers towards colorectal cancer screening, as well as the main barriers to both patient and provider participation. METHODS: a cross-sectional, observational study was performed of 511 professionals in Albacete Health District. Variables included views on screening effectiveness and cost-effectiveness, acceptance by providers and patients, barriers to participation, frequency of prevention recommendations, and education needs. RESULTS: most (76 %) considered screening was effective; 85 % said acceptance of fecal occult blood testing was intermediate or high, and 68.2 % this is also the case for colonoscopy when needed; 71.9 % would recommend screening should a population-based program be implemented (currently only 9.7 % recommends this). Correspondence analysis revealed that recommendation is more common when assigned populations are smaller. CONCLUSIONS: most providers consider screening is both effective and acceptable for patients. In today´s situation, where screening is only performed in an opportunistic manner, the proportion of professionals who commonly recommend screening for the mid-risk population is low, especially when assigned populations are huge.

[Colonization management of methicillin resistant Staphylococcus aureus in patients and health professional in the haemodialysis unit in a situation of high risk of endemic disease: looking for zero nasal carriers?]. / Manejo de la colonización por Staphylococcus aureus meticilin resistente, en pacientes y profesionales de una unidad de hemodiálisis, en una situación de elevada endemia: ¿objetivo cero?

AIMS: To describe the dynamics of colonization by methicillin resistant Staphylococcus aureus (MRSA) detected in the Haemodialysis Unit (UHD) of the Hospital San Pedro de Alcantara of Caceres due to the detection of catheter-associated infections. Additionally, we attempt to evaluate the effectiveness of preventive strategies introduced. METHODS: Nasal swab tests were performed in order to detect MRSA colonization in patients and health professionals from August 2008 to January 2009, according to the Consensus GEIH-SEIMC Y SEMPSPH Consensus. An active surveillance was performed with treatment and control of the carriers until negative results were achieved. A consensus document was drawn up in the UHD with registered preventive measures and work systems were reviewed. Prevalence, cumulative incidence, colonization pressure (carrier ratio per day/total patients or experts per day) were calculated. A chi-square test was performed, as well as a Z test for the comparison ratio. RESULTS: The nasal swabs of 54 acute and chronic patients on haemodialysis showed an initial carrier prevalence of 29.6%; cumulative incidence in patients of 42.6%. Nasal swabs of 48 professionals had a cumulative incidence of 39.5%. There was a parallel decrease in colonization pressure in patients and specialists. After five months A smear was performed 5 months later on 40 patients and 26 specialists, which showed no carriers among the patients, and one among the health professionals. CONCLUSION: We detected a high number of MRSA carriers among patients and Health professionals from the Haemodialysis Unit. Screening and treatment measures were effective for the decolonization of this population. It is important to adopt long-term strategies for active surveillance for the rapid detection of alert situations.

[Critical burn patient. Nursing care]. / Paciente quemado crítico. Cuidados iniciales.

Burns are now a major health problem with implications both for patients who suffer them, as for nurses who care for them. Burns can affect seriously the health of patients, can alter your entire body and cause the death. For nurses represent the care of a patient with a complex situation, where valuation is not easy and you need a comprehensive care, which requires an immediate response to prevent damage aesthetic, functional and psychological, and sometimes even death. It is intended to emphasize the importance of making a comprehensive assessment, rapid and comprehensive of those who suffer this type of injury to act immediately on those complications that can cause death.